Childbirth U ~ Confirmatory evidence that increasing MMR directly associated w/ high CS rate

by faithgibson on April 11, 2015

in Cesarean Politics, Contemporary Childbirth Politics, OB Interventions: Dubious or Detrimental

The following account of the CMQCC report on maternal mortality in California was written and circulated via email by Henci Goer. Hence in the founder & CEO of Childbirth U, a website that will provide science-based information of childbirth-related issues and intervention. The website is not on-line but will be soon.

Click on this URL to see more info about CBU 

California Study Analyzes Causes of Pregnancy-Related Mortality
& Proposes Preventive Measures reports on an analysis of pregnancy-related deaths in California. Turning to the study itself, a team reviewed all 207 cases of pregnancy-related death between 2002 and 2005 to ascertain, as the study title states, “causes, characteristics, and improvement opportunities.”

Pregnancy-related mortality rates in black women were shockingly high. Their mortality rate was 40 per 100,000 live births vs. 6-10 per 100,000 in the other racial/ethnic groups.

The five leading causes of maternal death were cardiovascular disease, preeclampsia, hemorrhage, venous clots, and amniotic fluid embolism, comprising 70% of the 207 deaths. Investigators confined the rest of the analysis to these five.

The role played by cesarean surgery weaves throughout the analysis. Among deaths from venous clots, 64% were repeat cesareans.

Seventy percent of hemorrhage deaths were due either to abnormal placental attachment, uterine cuts, or uterine rupture, all of which, as with venous clots, are more likely with–or, in the case of cuts, only occur duringcurrent or previous cesarean.

Among women with BMI equal to or more than 40 who died of venous clots, 89% were cesarean deliveries, which raises the question of the degree to which care provider belief about the ability of plus-sized women to birth vaginally results in avoidable cesareans that put them at excess risk.

Inductions are indicted as well. Among women dying of amniotic fluid embolism, 53% were induced compared with 21% of women dying of other causes. The authors note other studies finding the same association in the discussion section.

Factors contributing to preventable deaths include delayed response, suboptimal treatment, poor coordination of care, lack of patient education regarding warning symptoms, and overweight, which lead study authors to make the following recommendations:

  • cardiovascular disease: Provide pre-pregnancy counseling to improve heart health, including losing weight sensibly.
  • preeclampsia: Improve and standardize management of high blood pressure and educate women to recognize symptoms.
  • hemorrhage: Standardize care to ensure effective response.
  • venous clots: Approaches in addition to universal use of sequential compression devices on the legs of post-cesarean patients are under discussion.
  • amniotic fluid embolism: “Massive transfusion protocols with copious coagulation factors and intensive cardiovascular support may improve outcomes” (p. 946),

Information for AFE tells you how extreme danger it is and how little can be done about it.

Notably absent {from the published report} is any recommendation to reduce use of cesarean surgery and labor induction.

CBU therefore proposes an addition:

  • Strive to achieve vaginal birth whenever safely possible and limit use of induction to medical indications,
    because while addressing the problem is good, minimizing the possibility of it happening in the first place is infinitely better.

Henci speaking about CBU ~

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